Nutritional Quality Predicts Airway Hyperreactivity/Lung Injury in the World Trade Center-Health Program Fire Department of New York Cohort

Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. Pooling required time consuming steps: obtaining IRB approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY (n=16,221), WTCHR (n=29,372), and GRC (n=33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7,894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.

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Health Trends among 9/11 Responders from 2011–2021: A Review of World Trade Center Health Program Statistics

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000881 ◽

2021 ◽

pp. 1-6

Author(s):

Erin Smith ◽

Lisa Holmes ◽

Brigid Larkin

Keyword(s):

New York ◽

World Trade ◽

Health Program ◽

Smoking Status ◽

World Trade Center ◽

First Responders ◽

Fire Department ◽

Terrorist Attacks ◽

Health Trends ◽

Trade Center

Abstract Introduction: In a single day, the September 11, 2001 US terrorist attacks (9/11) killed nearly 3,000 people, including 412 first responders. More than 91,000 responders were exposed to a range of hazards during the recovery and clean-up operation that followed. Various health programs track the on-going health effects of 9/11, including the World Trade Center (WTC) Health Program (WTCHP). The objective of this research was to review WTCHP statistics reported by the Centers for Disease Control and Prevention (CDC) to analyze health trends among enrolled responders as the 20-year anniversary of the terrorist attacks approaches. Methods: The WTCHP statistics reported by the CDC were analyzed to identify health trends among enrolled responders from 2011 through 2021. Statistics for non-responders were excluded. Results: A total of 80,745 responders were enrolled in the WTCHP as of March 2021: 62,773 were classified as general responders; 17,023 were Fire Department of New York (FDNY) responders; and 989 were Pentagon and Shanksville responders. Of the total responders in the program, 3,439 are now deceased. Just under 40% of responders with certified health issues were aged 45-64 and 83% were male. The top three certified conditions among enrolled responders were: aerodigestive disorders; cancer; and mental ill health. The top ten certified cancers have remained the same over the last five years, however, leukemia has now overtaken colon and bladder cancer as the 20-year anniversary approaches. Compared to the general population, 9/11 first responders had a higher rate of all cancers combined, as well as higher rates of prostate cancer, thyroid cancer, and leukemia. Discussion: Trends in these program statistics should be viewed with some caution. While certain illnesses have been linked with exposure to the WTC site, differences in age, sex, ethnicity, smoking status, and other factors between exposed and unexposed groups should also be considered. Increased rates of some illnesses among this cohort may be associated with heightened surveillance rather than an actual increase in disease. Still, cancer in general, as well as lung disease, heart disease, and posttraumatic stress disorder (PTSD), seem to be increasing among 9/11 responders, even now close to 20 years later. Conclusion: Responders should continue to avail themselves of the health care and monitoring offered through programs like the WTCHP.

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Mortality among Fire Department of the City of New York Rescue and Recovery Workers Exposed to the World Trade Center Disaster, 2001–2017

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176266 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6266

Author(s):

Hilary L. Colbeth ◽

Rachel Zeig-Owens ◽

Charles B. Hall ◽

Mayris P. Webber ◽

Theresa M. Schwartz ◽

...

Keyword(s):

New York ◽

World Trade ◽

Service Providers ◽

Linear Trend ◽

World Trade Center ◽

Fire Department ◽

Smoking History ◽

The World ◽

Trade Center ◽

The City

The World Trade Center (WTC) attacks on 9/11/2001 have consistently been associated with elevated rates of physical and mental health morbidities, while evidence about mortality has been limited. We examined mortality between 9/12/2001 and 12/31/2017 among 15,431 WTC-exposed Fire Department of the City of New York (FDNY) firefighters and emergency medical service providers (EMS), specifically assessing associations between intensity of WTC-exposure and mortality risk. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) compared FDNY cohort mortality with the US general population using life table analysis. Deaths were identified via linkage to the National Death Index. Cox proportional hazards regression models were used to identify associations between intensity of WTC-exposure and mortality, accounting for age, sex, race/ethnicity, smoking history, and other relevant confounders. We identified 546 deaths and a lower than expected all-cause mortality rate (SMR = 0.22; 95% CI, 0.20–0.24). No cause-specific SMRs were meaningfully elevated. Mortality hazard ratios showed no association or linear trend with level of WTC-exposure. Our results provide evidence of the healthy worker effect, despite exposure to the World Trade Center. More follow-up time may be needed to assess the full impact of WTC-exposure on mortality in this occupational population.

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Injuries and Illnesses Among New York City Fire Department Rescue Workers After Responding to the World Trade Center Attacks

JAMA ◽

10.1001/jama.288.13.1581 ◽

2002 ◽

Vol 288 (13) ◽

pp. 1581 ◽

Cited By ~ 10

Keyword(s):

New York ◽

New York City ◽

York City ◽

World Trade ◽

World Trade Center ◽

Fire Department ◽

Rescue Workers ◽

The World ◽

Trade Center ◽

World Trade Center Attacks

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Combining Three Cohorts of World Trade Center Rescue/Recovery Workers for Assessing Cancer Incidence and Mortality

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041386 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1386

Author(s):

Robert M. Brackbill ◽

Amy R. Kahn ◽

Jiehui Li ◽

Rachel Zeig-Owens ◽

David G. Goldfarb ◽

...

Keyword(s):

New York ◽

World Trade ◽

World Trade Center ◽

Fire Department ◽

Analysis Data ◽

Cancer Registries ◽

Future Research ◽

Incidence And Mortality ◽

The World ◽

Trade Center

Three cohorts including the Fire Department of the City of New York (FDNY), the World Trade Center Health Registry (WTCHR), and the General Responder Cohort (GRC), each funded by the World Trade Center Health Program have reported associations between WTC-exposures and cancer. Results have generally been consistent with effect estimates for excess incidence for all cancers ranging from 6 to 14% above background rates. Pooling would increase sample size and de-duplicate cases between the cohorts. However, pooling required time consuming steps: obtaining Institutional Review Board (IRB) approvals and legal agreements from entities involved; establishing an honest broker for managing the data; de-duplicating the pooled cohort files; applying to State Cancer Registries (SCRs) for matched cancer cases; and finalizing analysis data files. Obtaining SCR data use agreements ranged from 6.5 to 114.5 weeks with six states requiring >20 weeks. Records from FDNY (n = 16,221), WTCHR (n = 29,372), and GRC (n = 33,427) were combined de-duplicated resulting in 69,102 unique individuals. Overall, 7894 cancer tumors were matched to the pooled cohort, increasing the number cancers by as much as 58% compared to previous analyses. Pooling resulted in a coherent resource for future research for studies on rare cancers and mortality, with more representative of occupations and WTC- exposure.

Download Full-text